The "End of the Road"

Tom Kirsch, M.D.
Emergency doctor and Go Team leader

I spent the last 3 days doing assessments. We were trying to identify areas with unmet needs to see if International Medical Corps can fill the gaps. We drove out of Port-au-Prince (PaP) to the west, down the long peninsula that reaches far into the Caribbean Sea to the towns of Leogane and Petit Goave. The road passes directly over the quake's epicenter and so the damage there was far greater than in PaP.

In some towns more than 90 percent of the buildings had collapsed. At points the road was ripped and roiled with larger fissures slashing along and across the road.

The area we went to was literally at the "end of the road."

The road started as a poorly maintained ribbon of asphalt that was more potholes than smooth and gradually faded away into a scrubby dirt track only suited for feet. Initially we drove through alternating areas of forest, banana or sugar cane farms, or crumbled towns. The dirt road started as a turn that ran south towards the mountains out of the town of Leogane through an essentially flattened town with few functioning buildings. Then it headed Southeast, paralleling a briskly flowing creek that was lined with shacks and concrete houses.

Only the shacks were really left because they were made of wood and palm fronds and metal sheets rather than the brittle and poorly reinforced concrete that crumbled into dust.

There were three scattered IDP (internally displaced people) camps along the roads. They were haphazard affairs with tents and shacks thrown together in closely-packed groups made from an assortment of tarps, scrap wood, and old, rusted corrugated metal sheets. The road ended at the last camp.

It was the worst of the lot. Only yesterday Save the Children had delivered tarps - which had been used to create shelters of a variety of interesting configurations. But there was nothing else there. They did have the creek which was used for drinking and washing and bathing and probably as a toilet.

All In a Day's Work

Tom Kirsch, M.D., Emergency physician and Go Team leader

For the most part I haul stuff, including patients. Yesterday I was an electrician and rewired a tent and put in more fans.

"He died two hours later."

Tom Kirsch, M.D.
Johns Hopkins emergency physician and Go Team leader

We work out of big, cream-colored tents, maybe 30 feet long and 15 feet wide. There are tents scattered all over the compound, from many different countries, but all with slight variations on the same design and a color range of white to tan. I guess they are the international standard disaster tent.

We have three tents for our ‘Triage Emergency Department’. Two tents stand out: the ‘Jiffy Pop’ (look that up those of you born into the microwave era), and the Blue Tent.

The Blue Tent is the infectious disease tent with six places for the emaciated people coughing blood that we think have advanced TB. There is an exceptionally brave and unassuming Infectious Disease fellow from California who works there, pretty much alone it seems. She is quiet and unassuming with dark hair and a serious look about her. And she risks her health and maybe even life every time she steps in there.

She works 10-11 hour shifts. At night the patients are alone to cough and gasp for breath, The patient I sent there yesterday was a 19-year old with what appeared to be advanced AIDS. He looked like one of those classic ‘refugees’ in a starvation area with racks of ribs cascading down his chest, sunken eyes and limp, lean arms and legs. By the time he got to us he was already breathing so hard that he had to sit upright and could only gasp out one or two word sentences. He was sweating and you could see every muscle in his torso working to drag in each breath.

We poured antibiotics, anti-malarials and fluids into him immediately, but because he reported coughing blood we moved him to our ‘isolation area’- the open space between our two tents under the shade of some trees. I moved his to the Blue Tent in the late afternoon knowing there was not much to do, but hoping the California doc could work some miracle.

The next morning I went by and was somewhat surprised to see him from under the tent flap still sitting in his bed. After donning an N-95 mask I went into to the dark cramped tent among the shrunken, slightly stirring bodies to get a better look. He sat exhausted and glassy-eyed, sweat streaming off of him and making small grunts with each breath. It took him all his remaining strength to keep himself breathing thru the night and now he had no reserves left. I just tuned and left.

He died two hours later.